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Diastasis recti abdominis (DRA). Your postnatal tummy explained.

by Kathryn Levy, DPT, CSP | 3 December 2020
A closeup shot of a woman's stomach after giving birth, showing the tummy gap in the centre of her stomach potentially caused by diastasis rectis abdominis. Her new baby's legs are resting over part of her stomach.

Many women will be concerned with the way their stomachs look and feel after they have a baby. They will often report their stomach muscles feel weak and tired often more towards the end of the day. They feel they still look pregnant, that their stomachs feel full and round.

Some women will notice a doming or a dipping above or below the tummy button when they move in a certain way, and they feel that something isn’t quite right. Women may report lower back pain, pelvic girdle pain, pelvic floor symptoms or bowel problems.

All of these symptoms can be signs of a diastasis recti abdominis, aka “a tummy gap” which can cause both short and long-term problems if left untreated.

What is a diastasis recti abdominis (DRA)?

A diastasis recti abdominis is defined as a separation between the recti abdominis muscle bellies, (aka your 6-pack muscles). All pregnant women will develop some degree of abdominal separation during their pregnancy. This usually happens in the third trimester, but it can also appear as early as the second trimester. It is a normal physiological change that happens during pregnancy to allow room for your baby to grow.

Your recti abdominis muscles run up the front of your abdominal wall from your pubic bone attaching to your sternum and ribs. The linea alba sits between the recti abdominis bellies and forms a fibrous line of connective tissue from your sternum to your pubic bone. As your bump grows, the recti abdominis and the linea alba will stretch and widen to create space for your baby to grow. This stretching and widening of both the recti abdominis and linea alba is what we refer to as a “tummy gap”.

For many women this abdominal separation will close naturally during the first 6-12 weeks postpartum. For others, the separation will persist causing a range of symptoms including pelvic girdle pain, lower back pain and pelvic floor muscle problems.

Many women will focus on the width of their gap, but what is far more important is what it feels like in between. When you contract your stomach muscles, the linea alba pulls taut acting as a bridge to connect the right and left side of your abdominal wall. If the linea alba loses its tension and becomes slack, you lose that bridge. And it is why you may see doming or dipping around the tummy button when you move in a certain way. The linea alba is what bulges or dips- not the recti abdominis.

What can you do about it?

Many women will turn to exercise first in an effort to treat their symptoms and close the gap. But not all exercise is created equal. In fact, overworking your stomach muscles too much and too soon can actually delay healing and make symptoms worse.

It is important to discuss your symptoms with a postnatal physiotherapist specialist who can help determine what exercises are best for you.

Tips to get you started:

During the first 4-6 weeks postpartum, consider using gentle abdominal support such as a soft binder or compression pants. Your abdominal muscles and linea alba may feel particularly vulnerable in the first few weeks postpartum. Giving them a bit of extra support can help the healing process in those early days and set the stage for a smoother recovery.

Focus on your breathing. Breath holding can cause a rise in intra-abdominal pressure which will put even more stress and strain on your stomach muscles and linea alba. Focus on taking nice restorative deep breaths where you feel your ribs expand and your tummy rise and fall. Try and exhale when you are doing things that require more effort like lifting the car seat or getting in and out of bed.

Avoid bracing your stomach muscles. You probably don’t even realise you are doing it, but you are. Abdominal bracing will cause more harm than good, so when in doubt relax your stomach muscles and go back to taking some nice restorative breaths.

We are here to help.

At Cambridge Health Clinic, we specialise in the assessment and treatment of diastasis recti abdominis and postnatal rehabilitation. We will fully assess your abdominal muscles at rest and with movement, for example squatting or lifting.

Yes, we will measure the width of the gap, but we will spend more time working on the muscles and linea alba themselves. We want to get your deep abdominal muscles switched on again. We will teach you how create tension along your linea alba to help build back that bridge.

Now when it comes to rehab, no two women are the same. Where we start depends entirely on who you are and where you are in your journey: your symptoms, your goals and your support networks. We will work with you to create an exercise programme that is realistic, manageable and most importantly, effective.

If you are ready, book in for your postnatal consultation here.

And for those of you who want or need a little more support, please read about our unique postnatal recovery programme here.